Self-Administered Drug Exclusion Update (J6 and JK)

Medications that are self-administered more than 50% of the time for all Medicare beneficiaries are excluded from Medicare Part B coverage. 

At the direction of CMS, each MAC shall create an article that includes all medications deemed self-administered, and thus excluded from Part B coverage. 

Please understand that effective 7/1/2025, article A53021 will apply to J6 and JK.

• J6 and JK Article – Self-Administered Drug Exclusion List: Medical Policy Article (A53021)

For additional details on classifying a medication as self-administered, please review the CMS Internet-Only Manual (IOM) Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50.2.

Revised 6/26/2025